Richard A. Gutstadt, P.C.
Northern California SSI & SSDI Appeals
510-992-6934

A Successful Disability Claim - More than Just a Diagnosis

The Social Security Administration's Five-Step Sequential Evaluation Process

     One of the things I hear most often from a client whose claim for disability is rejected is, "I can't believe Social Security turned me down for benefits, I told them I have [insert ailment/disease/injury]."

     What surprises clients even more is when I tell them that two people of the exact same age, with the exact same medical diagnosis, may not both be eligible for Social Security Disability benefits. In other words, a successful disability claim requires more than just a medical diagnosis.

     In the Social Security Administration's (SSA's) Five-Step disability analysis, the diagnosis of a severe, medically determinable impairment is required at Step Two. But having a severe, medically determinable impairment, in and of itself, does not prove that an individual cannot work.

     Once a severe, medically determinable impairment is established at Step Two, SSA is interested in how this impairment affects an individual's Residual Functional Capacity (RFC). RFC is defined by the SSA as "the most you can still do despite your limitations." Because the limiting effects of injuries and/or diseases can be different for different people, individuals with identical diagnoses may have vastly different RFC's.

     The RFC assessment is most important at Steps Four and Five of the disability analysis. At Step Four, the SSA asks whether an individual can do any of his/her past jobs. If it determines that the answer to this question is "No", the SSA moves to Step 5 and asks whether an individual can do any other work. An RFC assessment can be for a physical and/or a mental condition.

     For severe physical conditions, an RFC consists of an assessment of the individual's ability to engage in a variety of physical activities during an 8-hour workday, including the length of time you can sit/stand/ and walk, how much weight you can lift and how often you can lift it, the functionality of your upper and lower extremities, and several other categories.

     For severe psychological and psychiatric conditions, an RFC will consist of assessing an individual's capacities to understand and remember, stay focused on tasks, interact with other people, and adapt to changes in the workplace.

     For an individual to be successful in his/her claim for disability, that person must generally prove that there is no full-time employment that he/she can still do (1) on either a physical or mental basis, or a combination of the two. This is a difficult requirement, which means that securing experienced, competent legal representation for your claim is essential.

- Eric J. Patrick


(1) Exceptions to this rule based on age, education, and category of past work begin at age 50.

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